harn_36a_n.jpg and harn_36b_n.jpg: Findings during cystourethroscopy in two patients with recurrent urinary tract infections.
harn_36a_n.jpg: View of the trigonum with two orifices on the left side; the lower orifice is slit-like, the upper orifice is gaping and has a shape of a golf hole.
The diagnosis is complete ureteral duplication of the left side. The gaping orifice corresponds to the caudal ureter (lower renal part) and is responsible for the nearly
obligatory reflux.
The lower orifice which corresponds to the upper renal part (upper pole) has a normal configuration, opens only if a peristalsis wave arrives, and urine flows into the bladder.
harn_36b_n.jpg: On the right side, view of the posterior urethra with the colliculus in the centre, and to the crista urethralis which runs from the lower pole to both sides. And on the left side view of the more distally localized urethra with a circular fold corresponding to the external sphincter muscle.
The cystourethroscopy has still a significance in the work-up of vesicoureteral reflux. For instance, in the evaluation of the cause of reflux, of possible additional pathologies, of the state of the bladder concerning operability, and so on; and a significance in the work-up of obstructive uropathies of the upper and lower urinary tract, and of other pathologies (compare chapter 'Hematuria').